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__NOTOC__ | __NOTOC__ | ||
{{Blepharitis}} | {{Blepharitis}} | ||
{{CMG}} {{AE}} {{SR}} | {{CMG}}; {{AE}} {{SR}}, {{SaraM}} | ||
==Overview== | ==Overview== | ||
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. | Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. Antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause.<ref name="pmid21450919">{{cite journal| author=Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T et al.| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2050-64 | pmid=21450919 | doi=10.1167/iovs.10-6997g | pmc=3072163 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450919 }} </ref><ref name=Blepharitis PPP 2013> Blepharitis. American Academy of Ophthalmology. (2013). http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 </ref> | ||
Antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause. | |||
==Medical Therapy== | ==Medical Therapy== | ||
=== | |||
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. As blepharitis is a [[chronic]] disease, eyelid hygiene and regular cleaning must be performed even after an acute exacerbation has resolved. | ===General Management=== | ||
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. As blepharitis is a [[chronic]] disease, eyelid hygiene and regular cleaning must be performed even after an acute exacerbation has resolved. General management of blepharitis includes:<ref name="pmid21450919">{{cite journal| author=Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T et al.| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2050-64 | pmid=21450919 | doi=10.1167/iovs.10-6997g | pmc=3072163 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450919 }} </ref><ref name="pmid26031204">{{cite journal| author=Arita R, Morishige N, Shirakawa R, Sato Y, Amano S| title=Effects of Eyelid Warming Devices on Tear Film Parameters in Normal Subjects and Patients with Meibomian Gland Dysfunction. | journal=Ocul Surf | year= 2015 | volume= 13 | issue= 4 | pages= 321-30 | pmid=26031204 | doi=10.1016/j.jtos.2015.04.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26031204 }} </ref><ref name="pmid23118519">{{cite journal| author=Benitez-Del-Castillo JM| title=How to promote and preserve eyelid health. | journal=Clin Ophthalmol | year= 2012 | volume= 6 | issue= | pages= 1689-98 | pmid=23118519 | doi=10.2147/OPTH.S33133 | pmc=3484726 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23118519 }} </ref> | |||
*Warm compresses | *Warm compresses: heat can liquefy the abnormal solidified [[meibomian glands|meibomian secretions]] and increase the quantity of secretions. | ||
* | *Eyelid cleansing: gentle washing of the lashes and [[eyelid|eyelid margins]] with warm water, eyelid scrub solutions, or baby shampoo to remove the accumulated material. | ||
*Eyelid massage: massage may help empty the [[meibomian glands]] and improve secretion. | |||
*Antibiotics (topical and/or systemic): antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause. It is important to consider eyelid margin hygiene before applying the [[topical|topical therapy]]. | |||
*Topical anti-inflammatory agents (e.g., [[corticosteroids]], [[cyclosporine]]) | |||
===Antimicrobial Regimens=== | ===Antimicrobial Regimens=== | ||
*''' | *'''Blepharitis'''<ref>{{cite web | url = http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 | title = Blepharitis PPP 2013}}</ref> | ||
:*''' | :*'''1. Empiric antimicrobial therapy''' | ||
::*Preferred regimen: [[ | ::* Preferred regimen (1): [[Bacitracin]] topical one or more times daily or at bedtime for a few weeks | ||
::* | ::* Preferred regimen (2): [[Erythromycin]] topical one or more times daily or at bedtime for a few weeks | ||
::*Alternative regimen ( | ::* Alternative regimen (1): [[Metronidazole]] topical (for cases unresponsive to [[Bacitracin]] or [[Erythromycin]]) | ||
::*Alternative regimen ( | ::* Alternative regimen (2): [[Tobramycin]]/[[Dexamethasone]] ophthalmic suspension | ||
::*Alternative regimen ( | ::* Alternative regimen (3): [[Azithromycin]] sustained release | ||
::*Note: [[Cyclosporine]] 0.05% | ::* Note (1): Cure is usually not possible with blepharitis. Eyelid hygiene may provide symptomatic relief for both anterior and posterior blepharitis. | ||
*'''2. Specific considerations''' | ::* Note (2): [[Cyclosporine]] topical drops 0.05% may be helpful in some patients with posterior blepharitis. | ||
:*'''2.1 Meibomian gland dysfunction''': | :*'''2. Specific considerations''' | ||
::*Preferred regimen: [[Doxycycline]] 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks {{or}} [[Minocycline]] 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks {{or}} [[Tetracycline]] 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks. | ::*'''2.1 Meibomian gland dysfunction''' | ||
::*Alternative regimen (1): [[Erythromycin]] 250-500 mg PO qd for 3 weeks {{or}} [[Azithromycin]] 250-500 mg PO 1-3 times a week for 3 weeks {{or}} [[Azithromycin]] 1 g PO once per week for 3 weeks | :::*Preferred regimen: [[Doxycycline]] 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks {{or}} [[Minocycline]] 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks {{or}} [[Tetracycline]] 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks. | ||
::*Note: [[Tetracyclines]] are contraindicated among pregnant women, nursing women, and young children < 8 years of age | :::*Alternative regimen (1): [[Erythromycin]] 250-500 mg PO qd for 3 weeks {{or}} [[Azithromycin]] 250-500 mg PO 1-3 times a week for 3 weeks {{or}} [[Azithromycin]] 1 g PO once per week for 3 weeks | ||
:*'''2.2 Dry eye''' | :::*Note: [[Tetracyclines]] are contraindicated among pregnant women, nursing women, and young children < 8 years of age | ||
::*Preferred regimen: [[Cyclosporine]] 0.05% ophthalmic emulsion bid for 6 months | ::*'''2.2 Dry eye''' | ||
:*'''2.3 Ocular | :::*Preferred regimen: [[Cyclosporine]] 0.05% ophthalmic emulsion bid for 6 months | ||
::*Preferred regimen: [[Doxycycline]] 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks {{or}} [[Minocycline]] 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks {{or}} [[Tetracycline]] 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks {{or}} ([[Azithromycin]] 250-500 mg PO 1-3 times a week for 3 weeks {{and}} [[Tacrolimus]] 0.1% topical bid for 3 weeks) {{or}} ([[Azithromycin]] 1 g PO once per week for 3 weeks {{and}} [[Tacrolimus]] 0.1% topical bid for 3 weeks) | ::*'''2.3 Ocular rosacea''' | ||
*'''3. Pathogen-directed antimicrobial therapy''' | :::*Preferred regimen: [[Doxycycline]] 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks {{or}} [[Minocycline]] 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks {{or}} [[Tetracycline]] 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks {{or}} ([[Azithromycin]] 250-500 mg PO 1-3 times a week for 3 weeks {{and}} [[Tacrolimus]] 0.1% topical bid for 3 weeks) {{or}} ([[Azithromycin]] 1 g PO once per week for 3 weeks {{and}} [[Tacrolimus]] 0.1% topical bid for 3 weeks) | ||
:*'''3.1 Staphylococcus spp.''' | :*'''3. Pathogen-directed antimicrobial therapy''' | ||
::*Preferred regimen: [[Bacitracin]] ophthalmic ointment qhs for 2 weeks {{or}} [[Bacitracin]]/[[Polymyxin B Sulfate]] ophthalmic ointment bid to qid for 2 weeks {{or}} [[Erythromycin]]ophthalmic ointment qhs for 2 weeks {{or}} [[Azithromycin]] 1% ophthalmic solution bid for 2 days followed by qd for 12-26 days {{or}} [[Tobramycin]]/[[Dexamethasone]] 0.3%/0.05% ophthalmic suspension qid for 2 weeks | ::*'''3.1 Staphylococcus spp.''' | ||
:*'''3.2 Demodex folliculorum''' | :::*Preferred regimen: [[Bacitracin]] ophthalmic ointment qhs for 2 weeks {{or}} [[Bacitracin]]/[[Polymyxin B Sulfate]] ophthalmic ointment bid to qid for 2 weeks {{or}} [[Erythromycin]] ophthalmic ointment qhs for 2 weeks {{or}} [[Azithromycin]] 1% ophthalmic solution bid for 2 days followed by qd for 12-26 days {{or}} [[Tobramycin]]/[[Dexamethasone]] 0.3%/0.05% ophthalmic suspension qid for 2 weeks | ||
::*Preferred regimen: [[Metronidazole]] 2% gel bid for 1-2 weeks | ::*'''3.2 ''Demodex folliculorum''''' | ||
::*Alternative regimen: [[Ivermectin]] 200 microgram/kg once weekly for 2 weeks | :::*Preferred regimen: [[Metronidazole]] 2% gel bid for 1-2 weeks | ||
:::*Alternative regimen: [[Ivermectin]] 200 microgram/kg once weekly for 2 weeks | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
Latest revision as of 20:38, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2], Sara Mehrsefat, M.D. [3]
Overview
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. Antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause.[1]
Medical Therapy
General Management
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. As blepharitis is a chronic disease, eyelid hygiene and regular cleaning must be performed even after an acute exacerbation has resolved. General management of blepharitis includes:[1][2][3]
- Warm compresses: heat can liquefy the abnormal solidified meibomian secretions and increase the quantity of secretions.
- Eyelid cleansing: gentle washing of the lashes and eyelid margins with warm water, eyelid scrub solutions, or baby shampoo to remove the accumulated material.
- Eyelid massage: massage may help empty the meibomian glands and improve secretion.
- Antibiotics (topical and/or systemic): antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause. It is important to consider eyelid margin hygiene before applying the topical therapy.
- Topical anti-inflammatory agents (e.g., corticosteroids, cyclosporine)
Antimicrobial Regimens
- Blepharitis[4]
- 1. Empiric antimicrobial therapy
- Preferred regimen (1): Bacitracin topical one or more times daily or at bedtime for a few weeks
- Preferred regimen (2): Erythromycin topical one or more times daily or at bedtime for a few weeks
- Alternative regimen (1): Metronidazole topical (for cases unresponsive to Bacitracin or Erythromycin)
- Alternative regimen (2): Tobramycin/Dexamethasone ophthalmic suspension
- Alternative regimen (3): Azithromycin sustained release
- Note (1): Cure is usually not possible with blepharitis. Eyelid hygiene may provide symptomatic relief for both anterior and posterior blepharitis.
- Note (2): Cyclosporine topical drops 0.05% may be helpful in some patients with posterior blepharitis.
- 2. Specific considerations
- 2.1 Meibomian gland dysfunction
- Preferred regimen: Doxycycline 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks OR Minocycline 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks OR Tetracycline 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks.
- Alternative regimen (1): Erythromycin 250-500 mg PO qd for 3 weeks OR Azithromycin 250-500 mg PO 1-3 times a week for 3 weeks OR Azithromycin 1 g PO once per week for 3 weeks
- Note: Tetracyclines are contraindicated among pregnant women, nursing women, and young children < 8 years of age
- 2.2 Dry eye
- Preferred regimen: Cyclosporine 0.05% ophthalmic emulsion bid for 6 months
- 2.3 Ocular rosacea
- Preferred regimen: Doxycycline 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks OR Minocycline 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks OR Tetracycline 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks OR (Azithromycin 250-500 mg PO 1-3 times a week for 3 weeks AND Tacrolimus 0.1% topical bid for 3 weeks) OR (Azithromycin 1 g PO once per week for 3 weeks AND Tacrolimus 0.1% topical bid for 3 weeks)
- 3. Pathogen-directed antimicrobial therapy
- 3.1 Staphylococcus spp.
- Preferred regimen: Bacitracin ophthalmic ointment qhs for 2 weeks OR Bacitracin/Polymyxin B Sulfate ophthalmic ointment bid to qid for 2 weeks OR Erythromycin ophthalmic ointment qhs for 2 weeks OR Azithromycin 1% ophthalmic solution bid for 2 days followed by qd for 12-26 days OR Tobramycin/Dexamethasone 0.3%/0.05% ophthalmic suspension qid for 2 weeks
- 3.2 Demodex folliculorum
- Preferred regimen: Metronidazole 2% gel bid for 1-2 weeks
- Alternative regimen: Ivermectin 200 microgram/kg once weekly for 2 weeks
References
- ↑ 1.0 1.1 Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T; et al. (2011). "The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction". Invest Ophthalmol Vis Sci. 52 (4): 2050–64. doi:10.1167/iovs.10-6997g. PMC 3072163. PMID 21450919.
- ↑ Arita R, Morishige N, Shirakawa R, Sato Y, Amano S (2015). "Effects of Eyelid Warming Devices on Tear Film Parameters in Normal Subjects and Patients with Meibomian Gland Dysfunction". Ocul Surf. 13 (4): 321–30. doi:10.1016/j.jtos.2015.04.005. PMID 26031204.
- ↑ Benitez-Del-Castillo JM (2012). "How to promote and preserve eyelid health". Clin Ophthalmol. 6: 1689–98. doi:10.2147/OPTH.S33133. PMC 3484726. PMID 23118519.
- ↑ "Blepharitis PPP 2013".